9908007017J
Z _ %
PER
APPLICATION FOR CITY OF CUPERTINO NUMBE
y INSPECTION DIVISION PERMIT EXPIRAnON
REROOF PERMIT' (408) TI% -'.3'222 8 PERMIT EXPIRES IF WORK IS NOT STARTED
WITHIN 180 DAYS OF PERMIT ISSUANCE OR
' - 180 DAYS FROM LAST CALLED INSPECTION.
BUILDING ADDRESS -
?
RESIDENTIAL COMMERCIAL OTHER
OWNER'S-
HAZARDOUS FIRE AREA
/m
YES ❑ tl yes s I tired a Class A
NAME y ✓✓"'-�/✓lc /
i req
mW assentttly rs required!
assembly
NO ❑ IN6al - LC.B.O. 7
-
EXISTING ROOF COVERING
ADDRESS—L
PHONE —•3 (�
NUMBER OF EXISTING COVERINGS '
TO BE REMOVED TO BE RETAINED /
CONTRACTOR'S
L ASF'
NAME 11
,
ADDRESS
CITYs L
TYPE OF ROOF COVERING
EX
ds�i2R-3z-sA
PHONE
BUILT-UP ROOF
00 PpLICENSE
S /
jNUMBER'
ASPHALT SHINGLE [r=[,�
LICENSED CONTRACTORS DECLARATIONDI
hereby aflrm Tat I am licensed under provisions of Chapter g (commencing with Seaton
WOOD SHAKES7000)
of Division 3 of the Business end Professions Cads, entl my License Is In full tome are
FAUGA
•�(]ryneffect. 1999WOOD
SHINGLES ❑Lkeme
C Lb. Number
OTHER (SPECIFY) ❑
Date Conireaor
O'M�ER-BUILDER DECLARATION
I hemby adlrm that I ern exempt from the Conbeaors License Law for the following reason.
PROPOSED
(Sec. 7031.5, Business and Professions Code: Any city or county which requires, a permit to
construct, after, Improve,demolish, or repair any stmaurs, prior to he Issuance, also requires the
BUILT-UP ROOF Eleppllcent
far such permit to ale a signed statement that he Is licensed pursuant to the provlelone
_
of the Contractor's License Lew (Chapter B (commencing wsh Section 7000) of Division 3 of the
Business Professions Code) that he La Merefrom the basis for
and or exempt and the alleged
ASPHALT SHINGLES ❑ t
E
exemption. Any violation of Section 7031.5 by any applicant for a permit sub(pae the applicant to
e civil penalty of not more twin, hundred daisrw (.h
WOOD SHAKES
or wegeeasfslr Bale compensation, do
wage:
❑I,k, ownerthe
sthcbtre I net Intendedor offered
'the work, and the structure le net Intentlso or offered ler res (Sec. 7044, Business entl Pmtee-
an Prefers -
son,
sons Code: The Contractor's Ucenes Law claw not appy to an comer of property who bulk'e r
WOOD SHINGLES ❑
Improves thereon, and who does such work himself or through his own emptayeas, provided that
such Improvements are not intended or offered for sale. If, however, the building or Improvement
I, add within one year of completion, the owner -builder will have the burden of proving that he did
'OTHER (SPECIFY) ❑
not build or Improve for purpose of sale.).
0I, as owner of the property, em exclusNay wnfaaing with licensed contractors to construct
the praect (Sec. 7044, Business and Professions Code: The Contractor's Ucense Law doer, not
PROVIDE I.C.B.O. REPORT NO.
asp y to an owner of property who builds orlonvonusthereon, and who contracts ler such prolecte
-
Mm a contractor(') Ikanaeo pursuant to the Contractor's License Lew.
PROVIDE MFGR. INSTALLATION SPECS.
❑ I em exempt under Sec. ,B A P. C. ler Nle reason
Owner Aare
WORKER'S COMPENSATION DECLARATION _
APPLICATION DATE
VALUATION
PERMIT FEE
iso
I hereby affirm under penalty of penury one of the following declaration:
❑ I neve entl MII maintain a Certificate of Consent to self -Insure for Workers Compensation,
n pmvketl for by Seaton 3700 of the Labor Code, for Me performance of the work ler which this
�D/�O,
O a
Building
g
Pam Is issued,
-
GGG /
T,.
Sell IC
have and will malmun Workers Compensation In turenco, as required by Section 3700 of
m Labor Code, for the performance of the work for which this permit b Issued. My Workeh
_
1
sure
Compensation Ineurerce cartbr est Policy number are:
\
TO
Cam. Poley No
PERMIT AUTHORIZATION
/— DATE
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE N.o�
(This section need not oe completed If the permit le ler one hundred dollars (5100) or leas.)
of the worr which this permit is asued, I Mall not em icy
XatiI candy that In the performancek le
All be inspected to
y pervon In any nuru er so as to biome eublea to the Worker' Ca vwmtbn Lem a Cstl-
roofs shall prior arty roofing mater al ng
tornla.
installed. If a roof is installed without first obtaining an
ons 0 Applicant It "�^--�—�---
inspection, I agree to remove all new materials for inspection.
subject too En ow kers' Co pienmtIcIn prkavisixor this
of the Labor Code, you must toril�iwiitth comply
Applicant understands and will comply with all non point
with such provisions or this permit shell ba deemed revoked.
source regulations. -
I tartly met I have read this application and state Met ft above Information Is wrrecL I agree
to comply with all cry and county ordinances and ante Laws rolatng to building wrstrualon, and
All roof Coved b,ee cllass'C' or better.
hereby
wren/ authorize representatives of this tly to enter upon the above-mentlanetl Property ler In-'��,
�s-tto
Purposes.
(We) agree to sae, Indemnity and keep harmless the City of Cupertino a Intl IIedIIUes,
/(y
✓, d L 7 9
Judgments, wale and expenses which may In any way awue against eek City In coneequerce
SIGNATOR OF APPLICANT DATE
of the granting of this perms.
PRE -INSPECTION:
PLYWOOD:
IN -PROGRESS: ,
INSP. DATE
INSP. - DATE
INSP. DATE
TEAR OFF INSPECTION:
BATTENS:
FINAL:
INSP. DATE
INSP. DATE
INSP. DATE
NOTE' OSHA APPROVED ACCESS TO ROOF SHALL BE PROVIDED FOR INSPECTION
OFFICE COPY
INVOICE INVOICP INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE INVOICE
Y CITY OF CUPERTINO
BUILDING PERMIT INVOICE OPERATOR: karenb
Sec: Twp: Rug: Sub: Blk: Loc:34212087.00
INVOICE DATE......: 08/10/1999
REFERENCE ID N ...: 99080070
SITE ADDRESS .....: 10190 BYERLY CT
SUBDIVISION .......
CITY .............: CUPERTINO
IMPACT AREA .......
OWNER ............: SCHAFFER GREGORY L AND SUSAN M
ADDRESS ...........
CITY/STATE/ZIP ...: CUPERTINO CA, CA 95014-5647
CONTRACTOR .......: MCCARTHY JR, MICHAEL LIC 4 21043
COMPANY ..........: MCCARTHY INDUSTRIES INC
ADDRESS ..........: 845 COMMERCIAL ST
CITY/STATE/ZIP ...: SAN JOSE, CA 95112
TELEPHONE ........: 4084361560
FEE DESCRIPTION CHK
_______________ __-
BPERMFEE P
BSEISMICRE P
ID DESCRIPTION
...................
FRAME
601 ROOF TEAR OFF
603 ROOF BATTENS
•
TOTAL FEE PAID -TO -DATE BALANCE DUE
197.00 0.00 197.00
1.40 0.00 1.40
--------- ------------ -----------
198.40 0.00 198.40
_--_--__ VOICE ID - DESCRIPTION
........ ...... .....
307 INSULATION
602 ROOF PLYWOOD NAIL
604 ROOF IN -PROGRESS